Analysis Of Death Rates Left To Everyone, No One

March 22, 1987|by BOB WITTMAN JR. And ANN WLAZELEK, The Morning Call

The same is true of cervical cancer, which can be cured if diagnosed early enough. So almost all incidents of cervical cancer could be eliminated if everyone in a community submitted to regular screening.

But even this sweeping examination doesn't begin to tell how dollars should be allocated, how personnel should be deployed and how facilities should be organized so the health care system would be best used. Those are conclusions left for others to reach.

Gary Gurian is another one who has tried. Allentown's health director says Americans spend $400 billion for health care each year but spend much of it in all the wrong places. He likes to cite the fact that although 96 percent of the health care dollar is used to treat people once they are sick and that although only 4 percent is spent on programs designed to keep people well, 80 percent of today's medical problems are preventable. So Gurian believes the money should be distributed to places where it could have a greater impact.

"I've said this 400,000 times," says he.

Gurian would find ways to systematically modify people's bad habits so they would eat more nutritious foods and become less reliant on abusive substances likedrugs, alcohol and tobacco. He'd correct work site and environmental hazards. He'd improve the accessibility of basic medical services, especially for poor pregnant women, and he'd offer incentives for people to stay healthy by revamping the ways society has relied on business and government to finance the cost of the health care system.

Last October, Gurian explained some of his views to a committee of the National Academy of Sciences in Boston and incurred criticism from both his employers at City Hall and from local hospital administrators when he went on to say that in spite of the explosive growth in the Lehigh Valley's medical care system, Allentown's health statistics are "no better than those areas of the state served by a less sophisticated system."

Gurian was not entirely correct, because an examination of the mortality rates he used shows the region to be at least as healthy in some years for some diseases as other parts of the state. But his critics might have argued anyway that it is certainly as important to deliver the best and speediest care to the people who really need it - the sick - than to expend resources on the well if the only intent is to achieve better mortality rates.

In fact, HealthEast - which has been critical of Gurian but which declined to comment in the preparation of this story - has said it is as committed to disease prevention as it is to primary care, and it recently appointed a vice president for disease prevention and health promotion. It has organized community colon-rectal screening programs, for example, and it has said its ongoing investment in sophisticated technology has allowed it to offer some of the best diagnostic work available anywhere. The sides were never as far apart on the issue as their vociferous public debate sometimes made them seem.

With national and state objectives in place that consider more than just how many hospital beds a community might need, health care planners are at least beginning to make improvements in the way society cares for itself - and there's already some indication that mortality rates are on the decline.

For example, the Public Health Service's 1986 report, "The 1990 Health Objectives for the Nation: A Midcourse Review," says that infant mortality has dropped from 13.8 deaths per 1,000 live births in 1978 to 10.6 in 1984. The death rate for automobile accidents fell from 23.6 per 100,000 people in 1978 to 19 percent in 1983.

And Joseph A. Califano, former secretary of the U.S. Department of Health, Education and Welfare, reports in a recent book, "America's Health Care Revolution," that since 1970, Americans have experienced a 25 percent decline in deaths from coronary heart disease - mostly because of the decline in cigarette smoking and in the consumption of cholesterol. In contrast, coronary care units accounted for only 13.5 percent of the improvement, cardiopulmonary resuscitation accounted for only 4 percent, bypass surgery accounted for only 3.5 percent and the widely used hypertension pills accounted for only 9 percent.

So it was a change in personal habits, rather than the reliance on advanced medical technology, that has been responsible for saving more than half of those lives.

Dr. Robert Ziegenfus is a professor of geography at Kutztown University. He calls himself a medical geographer.